HCPCS S0265 Fee Schedule
Last Updated: August 2025
Healthcare providers use this code to document and receive reimbursement for visits that address moderate-level medical decision-making, often including multiple diagnoses or prescription management.
| Key Fact | Detail |
|---|---|
| Service Type | • Temporary National Codes (Non-Medicare) • Miscellaneous Provider Services |
| Common Place of Service | • 11 - Office • None • 22 - On Campus-Outpatient Hospital |
| Common Modifiers | |
| Complexity Level | Moderate |
National average reimbursement for HCPCS S0265 by major payers:
$46.08
$32.61
$30.74
$71.49
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Use our free lookup tool to explore fee schedules and reimbursement rates for any billing code. Select a code type, then type or select a code to view its details.
Related Codes
What is a fee schedule?
A fee schedule is a list of fixed prices that healthcare providers charge for specific services, including HCPCS S0265. These prices vary depending on payer type (Medicare, Medicaid, private insurance), geographic location, and provider contracts.
Understanding the S0265 fee schedule helps patients estimate costs and providers optimize billing for accurate reimbursements.
Factors that affect fee schedules
Medicare & Medicaid Rates
Government-set reimbursement amounts
Private Insurance Rates
Negotiated rates between providers and insurance companies
Geographic Location
Costs may be higher in urban areas.
Provider Type
Hospital providers may have different rates than private practice.
HCPCS S0265 vs. Other Miscellaneous Provider Services Codes
The HCPCS S0265 code is part of the Temporary National Codes (Non-Medicare) services used for Miscellaneous Provider Services. It represents a moderate-complexity encounter and is one of several codes that vary based on time spent, level of medical decision-making, and documentation requirements.
The HCPCS S0265 code involves more provider time and moderate medical decision-making, unlike lower-level codes that require less time and simpler assessments. It typically includes multiple diagnoses, medication management, or test interpretation, leading to higher reimbursement and more detailed documentation requirements.
| HCPCS Code | Complexity Level | Description |
|---|---|---|
| S0260 | Low | History and physical (outpatient or office) related to surgical procedure (list separately in addition to code for appropriate evaluation and management service) |
| S0265 | Low | Genetic counseling, under physician supervision, each 15 minutes |
| S0270 | Low | Physician management of patient home care, standard monthly case rate (per 30 days) |
See what providers are getting paid in 2025 for S0265:
HCPCS S0265 Fee Schedule & Reimbursement Rates
The HCPCS S0265 fee schedule varies by payer type. Below are Medicare rates for 2025 and average in-network rates by state across major payers:
Reimbursement rates depend on provider contracts, region, and payer. Always verify rates with your insurance provider or medical billing department.
What is price transparency?
The Price Transparency Rule is a federal law that took effect in July 2022, requiring all commercial payers to publicly disclose their prices through machine-readable files (MRFs). In short, this regulation mandates that insurance companies make healthcare costs transparent to the public.
Our data comes directly from these insurer-posted MRFs, ensuring compliance with the Price Transparency Rule. While PayerPrice is working toward a future where providers and payers collaborate for 100% upfront price certainty, it's important to acknowledge that data limitations and occasional errors may exist.
Healthcare Price Transparency Rule
cms.govConsumer Guide To Healthcare Prices
aha.orgGlossary of Healthcare Terms
healthcare.govUnlock access to price transparency insights today.
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